Aug 17, 2017

Doctors see firsthand the toll that today’s increasingly stressful
society takes on patients: Engineers, office managers, teachers, you
name it. Work demands have increased, as has multitasking. Demands
outside the workplace add additional stress. Often parents chauffeuring
children to multiple activities must also care for aging parents with
increasing needs. Electronic devices, always in hand or close by,
command our attention (because of work or personal needs), sometimes
simultaneously. Finding a moment to catch one’s breath is as difficult
as getting enough sleep.

Doctors also see stress mounting in the mirror. We struggle to keep
an even keel while facing growing demands above and beyond caring for
our patients. Study after study, survey after survey
shows that increasing responsibilities – many taking physicians’ time
away from personal interaction with patients – are taking away some of
the joy in a profession to which we have dedicated our lives and our
hearts.

Overcoming ‘Paperwork’ Fatigue

I wouldn’t call it “burnout.” That term suggests giving up or
throwing in the towel. It’s more about having the resiliency to meet
today’s challenges. Mostly, we’re frustrated and exhausted by
administrative and clerical tasks, both in electronic and paper form,
pulling us away from our patients. Even ownership of the physician
clinical note is tainted by the regulatory burdens related to coding and
discrete data documentation for analytics and quality measurements.

The challenge of resiliency needs to be a priority not only for
physicians, but the healthcare systems to which they belong. There’s no
single cause, but a lot of it is epitomized by the electronic medical
record (EMR), particularly among seasoned physicians moving well beyond
the paper records they started with at the beginning of their careers.

A December 2016 American Medical Association study
starkly spotlighted the problem: for every hour of face-to-face time
devoted to patients, physicians spent almost two hours on EMRs and other
clerical work. With patient loads jumping and individual patient needs
rising, physicians need better tools to maintain their resiliency.

Austin Regional Clinic has recognized the challenge of physician
resiliency and is trying to address it on several fronts. For example,
we have a team working full-time on optimizing EMR efficiency. Can we
cut the number of computer clicks for each task? Something as simple as
ordering a prescription – a task physicians used to do by scribbling a
note on a paper pad – can take dozens of clicks while searching through
lists of medications, dosages and more.

We’re creating common order sets (called “smart-sets”), preference
lists with repetitive orders and medications, and other shortcuts in our
EMR to reduce the number of clicks required for common tasks. We also
have a team of “specialists” dedicated to meet with physicians onsite at
their clinics to help optimize individual EMR workflows and
preferences.

EMR vendors have not been able to place the focus needed on improving
the user interface, largely due to the burdens of meeting ever-growing
regulatory demands for national programs such as Meaningful Use and
MACRA (Medicare Access and CHIP Reauthorization Act). However, the
software’s interface with physicians should be improved, and ARC is
committed to doing all it can.

Another way to lighten physicians’ clerical loads: scribes
who can join physicians during patient visits and assist with EMR
documentation, ordering and other electronic clerical tasks in real
time. ARC had a successful pilot program and is currently offering
scribes to additional physicians who may be interested. We also have
advanced practice clinicians, acting as “extenders” to physicians,
performing and documenting routine exams such as Medicare wellness
check-ups.

Meanwhile, savvy professionals in many fields are turning to mindfulness, meditation and other “me time” activities
to reduce stress. They also can and should turn to each other on this
issue, viewing it as a mentoring topic. A very effective antidote for
decreased resiliency is the professional, day-to-day interaction between
physicians, like discussing diagnostic and treatment challenges or the
joys of those successes. Time challenges have led to fewer of those
interactions. ARC is working on some upcoming formal programs to provide
physicians with some of these stress-reducing tools.

Healthcare systems and medical groups should partner with physicians
to enhance their resiliency. They have an obligation to do what makes
sense to keep physicians enthused and performing at the highest level.
The best place to start? Allow physicians to do more of what they do
best – heal patients – and less of what others can do – computerized
paperwork and administrative tasks.